Senior Process Associate - Claims Adjudicator (Ambattur)

Cognet Hr Solutions; Chennai District; On-site; INR 600,000 - 900,000; Full time

Job summary

Cognet Hr Solutions in Ambattur, Chennai, seeks a Senior Process Associate for US Healthcare Claims Adjudication. You will handle end-to-end claims processing, ensuring adherence to CMS, HIPAA and client policies, with emphasis on accuracy and timely service.

The role requires 4–6 years of relevant experience, knowledge of CPT/ICD-10/HCPCS, and proficiency in claims systems. You will work US day/night shifts, join immediately or with short notice, and contribute to audits and process

Qualifications

• Experience in end-to-end US healthcare claims adjudication.
• Strong understanding of CPT, ICD-10, HCPCS and medical terminology.

Responsibilities

• Review and adjudicate insurance claims (medical/health/benefits) as per policy terms and procedures.
• Verify claim details, eligibility, coverage, and supporting documentation.
• Identify errors, discrepancies, and missing information; follow up as needed.
• Ensure accurate payment, denial, or adjustment of claims within defined SLAs.
• Calculate claim payments based on contracts and company rules.
• Meet productivity, quality, and turnaround time targets.
• Participate in audits, quality reviews, and process improvement initiatives.
• Confirm member eligibility, benefits, and required documents.
• Analyze existing processes and identify areas for optimization and efficiency gains.
• Update claim details and notes correctly in the system.

Skills

Claims processing systems

Written and verbal communication

US health insurance knowledge

Adjudication processes & benefit plans

Education

Any Graduate

Job description

US Healthcare Claims Adjudication Senior Process Associate

Job Title

Senior Process Associate

Experience Required

4 6 Years

Timing

6:30 pm - 3:30 am

Job Summary

We are looking for an experienced US Healthcare Claims Adjudication Specialist with strong knowledge in end-to-end claims processing and payer guidelines. The candidate will be responsible for adjudicating medical claims accurately while ensuring compliance with CMS, HIPAA, and client-specific policies.

Key Responsibilities

• Review and adjudicate insurance claims (medical/health/benefits) as per policy terms and procedures
• Verify claim details, eligibility, coverage, and supporting documentation
• Identify errors, discrepancies, and missing information; follow up as needed
• Ensure accurate payment, denial, or adjustment of claims within defined SLAs
• Calculate claim payments based on contracts and company rules
• Meet productivity, quality, and turnaround time targets
• Participate in audits, quality reviews, and process improvement initiatives.
• Confirm member eligibility, benefits, and required documents
• Analyze existing processes and identify areas for optimization and efficiency gains.
• Update claim details and notes correctly in the system

Skills Required

Proficiency in claims processing systems & Strong written and verbal communication skills & Robust knowledge of claims adjudication processes and benefit plans& US health Insurance Knowledge.

Required Skills

• Strong knowledge of US healthcare claims adjudication process.
• Good understanding of CPT, ICD-10, HCPCS, and medical terminology.
• Experience in handling commercial, Medicare, and Medicaid claims.
• Knowledge of denials management and appeals processing.
• Familiarity with payer policies and insurance guidelines.
• Strong analytical and problem-solving skills.
• Good communication and interpersonal skills.
• Proficiency in MS Office and claims processing systems.

Eligibility Criteria

• Any Graduate.
• 4 6 years of relevant experience in US Healthcare Claims Adjudication.
• Experience in handling high-volume claims processing environments preferred.

Preferred Skills

• Experience working with multiple payers and claim platforms.
• Exposure to quality audits and compliance processes.
• Ability to work independently and manage priorities effectively.

Work Location

Ambattur, Chennai

Shift

US day shift / Night Shift

Notice Period

Immediate Joiners or candidates with short notice period preferred. .